Dissociative Identity Disorder

Formerly known as Multiple Personality Disorder, it’s a mental illness that has received loads of attention in recent years. Portrayed in movies like Split, the idea that someone can switch between alternate personalities has fascinated and captivated the public’s attention for decades. But what is the reality of this mysterious disorder, and is it truly as dramatic, or perhaps even as dangerous, as it’s been depicted in popular media? Join us today as we explore what we know about the elusive nature of Dissociative Identity Disorder, and the controversy it has stirred up in the field of psychology.

Symptoms

The first thing you need to know about the symptoms of DID is that they can vary pretty significantly from patient to patient, both in the way that they manifest and in their severity. However, to help medical professionals accurately diagnose the disorder, there are several symptoms that have been nailed down as the standard indicators of Dissociative Identity Disorder, and we’ll be basing this off of the DSM-5, a diagnostic manual published by the American Psychiatric Association.

Of the criteria laid out in the DSM-5, the first, known as Criterion A, is likely the one that immediately jumped to your mind when you clicked on this video: the disruption of one’s identity by the existence of two or more distinct personality states in an individual. This is the defining characteristic of Dissociative Identity Disorder, and can manifest itself in a few ways: The one most people are familiar with is that some patients report, and have been observed, to suddenly switch to an alternate personality, which can have a different temperament, sense of humor, or even slightly different handwriting. These alternate personalities are commonly referred to as alters, and while most have only a select few alters, the average number has been increasing in recent years, and some have reported more than 100. Alters can be anything, a different gender, different age, or even a different ethnicity.

Preferences for food and music may rapidly shift back and forth between alters, as can political views, general outlook on life, and the person may report that their body feels different than normal. But this isn’t the full story. Other individuals experiencing Criterion A symptoms may not display the traditional switch to another personality, rather, they may suddenly feel depersonalized from their own body, reporting that they feel more like an observer in their own mind, unable to influence their own actions or speech.

These periods of dissociation are frightening, especially since they are often accompanied by intense emotions or desires, all while the individual feels powerless to stop it, as if they’re watching a movie in their own head. In highly religious communities, these periods of helplessness or alternate personalities may be interpreted as possession by a demon or spirit.

Interestingly, these symptoms can be so disruptive to one’s life that family and friends are often the ones who first take note of them, as they can be so extreme that even the roller coaster of teenage emotion isn’t enough to explain the behavior. This is in contrast to the next set of symptoms which isn’t as obvious to those around you, Criterion B.

Criterion B is characterized by recurrent amnesia or gaps in memory. People may forget everyday events, like which store they just went to or when they woke up, or they may forget entire periods of their life, such as important personal information, childhood events, or their own wedding. Some even report lapses in their memory regarding everyday functioning, such as forgetting how to use a computer, unlock their smartphone, or navigate their hometown. They may also stumble across evidence of actions they don’t remember, such as finding new items around the house that they don’t remember buying.

One of the more concerning ways these so-called ‘dissociative fugues’ can present themselves is in travel. People with DID may report that they suddenly ‘woke up’ or became aware of their surroundings at the beach or at work, with no recollection of how they came to be there. While there have been extreme cases of traveling to new cities, people commonly report suddenly being in a different part of their home. Imagine that one minute you’re watching this video, and after you blink you’re suddenly sitting on the floor in your closet.

You can understand just how distressing that would be.

The final criteria for a diagnosis of DID specify that the symptoms aren’t better explained by other medical conditions, like seizures, and are not the result of substance abuse. Additionally, if the patient is a child, medical professionals need to be certain that the symptoms aren’t the result of imaginary friends or some other fantasy play.

So that’s a lot of symptoms, and individuals can report various combinations of what we’ve just described. Other symptoms that commonly accompany DID but not always present are things like self-harm, depression, and anxiety, which can make it even harder for medical professionals to find the true cause. But even with all this, there’s one part that still remains quite the mystery to experts, and that’s what causes it all in the first place.

Controversial Causes

DID and what causes it is one of the most controversial subjects in modern psychology, and the field is actually quite divided on the topic. Generally, there are three different positions that experts take regarding the disorder.

The first stance is that the Dissociative Identity Disorder does not exist in the first place. Though this view isn’t nearly as popular as the other two, it is still held by several researchers. They posit that the symptoms of DID are too vague and simply left up to interpretation by clinicians, which can vary wildly. One study in 1993 found that the symptoms of DID are virtually indistinguishable from those of borderline personality disorder, or BPD.

A second analysis down this path found that 64% of patients with DID indeed met the criteria for BPD instead, but the remaining 36% did not, leading the researchers to conclude that DID does exist, but is simply over-diagnosed. The belief that DID is outright fake isn’t helped by the fact that many people on social media pretend to have the disorder for those juicy internet points, from YouTube to TikTok there’s really no shortage of it. But this isn’t really a new phenomenon, from Tourette’s to literally blindness, there have always been people faking medical conditions for a myriad of reasons, so this is only to be expected with something as well-known and as unique as DID.

But what you can’t fake are brain scans. Emerging evidence in neuroimaging has shown that there are actually detectable differences in the brains of people that dissociate, something which can’t be explained away by either BPD or faking symptoms. For example, a 2006 study found that cerebral blood flow is different in those with DID compared to those without, with some of the most significant differences found in the amygdala, an area of the brain responsible for emotion.

Another study in 2021 found that those with DID have a slightly smaller hippocampus, an area of the brain that plays a major part in memory and learning. So clearly something real is happening here, and we can safely discard the idea that the disorder doesn’t exist at all.

That brings us to the second explanation, that the disorder is caused by trauma.

More than 90% of people with Dissociative Identity Disorder report some form of abuse in their childhood, an incredibly high correlation. Whether it be neglect, sexual or physical abuse, this early-life trauma seems to be a critical step in the development of DID. Aside from abuse, people have also reported scarring memories of terrorism, painful medical procedures, or war, so it’s also possible that a single, overwhelmingly traumatic event can have a similar effect on the disorder’s development.

But how the brain transforms this trauma into periods of dissociation isn’t quite clear. Some researchers have suggested that when emotional damage is so extreme, people may begin dissociating as a way of escaping reality to deal with the pain. For a child, whose sense of self isn’t very concrete, this coping mechanism may disrupt their perception of who they are and be the trigger for developing DID further down the road.

But this doesn’t answer all the questions, as there are also plenty of individuals with Dissociative Identity Disorder who either experienced their trauma later in life as an adult or didn’t experience it at all. It also doesn’t explain why some people develop the disorder early in life, like at age 10 or 11, while others don’t even begin showing symptoms until much later in life.

Others have suggested that the development of DID requires the intense trauma to be coupled with a genetic predisposition, meaning that there may be some biological trigger for the disorder that is activated at some point in their life, awakening the symptoms that were lying dormant in the person. This approach is called the biopsychosocial perspective, taking into account the influence of several domains of life, like brain chemistry, life experiences, and thinking patterns. The biopsychosocial view is generally our best explanation for the causes of other disorders like schizophrenia or depression, so it only seems logical to apply it to DID, we just don’t seem to have all the details yet.

This brings us to our third and final explanation, that DID is brought about by certain controversial forms of psychotherapy. Proponents of the so-called ‘therapy-induced model’ suggest that patients experiencing other mental illnesses, such as borderline personality disorder, become suggestible in the presence of a therapist who tells them that they may have DID while performing something like hypnotherapy or while attempting to uncover repressed memories. Attempting to uncover repressed memories through hypnosis is something you’ve probably seen in a movie at some point, but it has absolutely no basis in science, and recent evidence shows that instead of recovering old, lost memories, it is actually quite powerful at creating new, entirely false ones.

This is why some believe that the symptoms of DID, and perhaps memories of the trauma itself, are created through these questionable practices.

Evidence for this includes a small number of clinicians accounting for a large percentage of actual diagnoses, and the fact that rates of the disorder are higher in the United States and Canada than in the rest of the world. They also point to the fact that most patients initially report the dissociative fugues and amnesia, and only later begin to open up about more bizarre alters, like animals or even mythological beings.

It’s also been suggested that aside from some unscientific therapy practices, symptoms may be egged on by self-diagnosis or a diagnosis from parents, which may explain why rates of the disorder have increased dramatically in the last few decades as movies and TV shows have brought it to the public’s attention. The brain is a powerful machine, and if you strongly believe that you have DID, it may be possible to begin genuinely showing the symptoms of what you believe the disorder to be.

Prevalence and Treatment

Whichever of these explanations you believe, there is one thing that can be agreed upon: something is going on here. Whether you believe it to be therapy-induced, brought on from trauma, or simply biological in some way, at the end of the day, these are real people with real issues. While estimates vary between studies, likely .5 to 1% of the population in the western world suffers from DID, and many try to hide their symptoms out of shame, especially if there was severe abuse that they’ve yet to tell anyone about.

And no, you shouldn’t be worried that someone with DID will dissociate to a violent alter and attempt to murder you, like they’ve been known to do in Hollywood. After all, it’s a classic movie courtroom scene, attempting to plead insanity on the grounds that a different personality is the one that actually committed the crime.

And as fantastical as it sounds, there have been a few interesting real-world court cases where the defense has claimed DID as the true culprit. Arguably the most popular of these is Billy Milligan, who was charged in 1977 with several counts of sexual assault, aggravated robbery, and kidnapping. Milligan’s defense claimed that his alternate personalities had been the ones to commit the crimes, and, surprisingly, the court went for it.

Milligan’s insanity defense had worked, and instead of prison he was committed to a psychiatric hospital, from which he later escaped, and then possibly committed two more murders. Among his 24 personalities was a wealthy, intelligent British scientist, a three-year-old girl, an escape artist, a Yugoslav explosives expert, who was blamed for his robberies, and a shy, 19 year-old lesbian, who was blamed for the assaults.

You can decide whether you believe him, or if you think it was a convenient way to get away with his many felonies. Just remember that violent cases like this are incredibly rare. Sufferers of DID are far more likely to be victims themselves than to harm anyone else. In fact, as many as 70% of people diagnosed with DID attempt to take their own life at some point, while their rates of harming others are no higher than that of the general population.

And this is why it is crucial to treat the disorder as effectively as possible, but the results are a bit mixed.

Currently, there is no specific medication for Dissociative Identity Disorder, though other meds are often prescribed for coexisting conditions, such as depression. Because we can’t rely on medication, therapy is really the only treatment we can turn to.

The approach a therapist takes varies from patient to patient depending on their needs, but the most common goal is to reintegrate the alters back into a single, stable self, so the patient can return to normal function with their memory complete. This is achieved through many, many therapy sessions, usually lasting several months or years, as the patient works to not only come to terms with their dissociative states, but to gain more control over them. It’s also crucial for the therapist to treat any other issues the patient is facing alongside DID, such as eating disorders or self-harm.

However, unlike more well-understood conditions, it’s difficult to predict if or how well someone will recover from DID. Prognosis for people in their teenage years is quite good, with the majority reporting either complete remission or significant improvement after 6 months, but there’s a considerable gap in the literature regarding long-term success. Only a handful of studies have continued to follow up with patients 5 years after treatment, so how well these people go on to function in adulthood in the long-run isn’t very well known.

In the coming years, we will likely begin to uncover more about this mysterious disorder, especially as the technology for brain imaging rapidly advances and more and more people come forward seeking treatment. If you believe that you or someone you know may be suffering from DID, please do not self-diagnose. It is always best to seek out a doctor or mental health professional who can properly assess you and get you the treatment you need. If you are in the United States, apa.org has a list of free hotlines, which includes a directory of DID experts around the country.

Key Takeaways

• Dissociative Identity Disorder (DID) involves two or more distinct personality states, with symptoms varying in manifestation and severity.
• DID symptoms include identity disruption, recurrent amnesia, and gaps in memory, often noticed by family and friends.
• Controversial causes of DID include trauma, genetic predisposition, and potentially therapy-induced factors.
• DID is relatively rare, affecting about 0.5 to 1% of the western population, with sufferers more likely to be victims than perpetrators.
• Treatment for DID primarily involves long-term therapy to reintegrate alters and manage coexisting conditions.

Frequently Asked Questions

What is Dissociative Identity Disorder (DID)?

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a mental illness characterized by the disruption of one’s identity by the existence of two or more distinct personality states in an individual.

What are the standard indicators of Dissociative Identity Disorder?

The standard indicators of DID include the disruption of one’s identity by the existence of two or more distinct personality states, recurrent amnesia or gaps in memory, and symptoms that are not better explained by other medical conditions or substance abuse.

What are ‘alters’ in the context of DID?

Alters are alternate personalities that individuals with DID may exhibit. These alters can have different temperaments, senses of humor, handwriting, and even different genders, ages, or ethnicities.

What is Criterion A in the diagnosis of DID?

Criterion A refers to the disruption of one’s identity by the existence of two or more distinct personality states in an individual, which is the defining characteristic of Dissociative Identity Disorder.

What is Criterion B in the diagnosis of DID?

Criterion B is characterized by recurrent amnesia or gaps in memory, where individuals may forget everyday events, important personal information, or even entire periods of their life.

What are some controversial causes of DID?

The controversial causes of DID include the belief that it does not exist, that it is caused by trauma, and that it is brought about by certain forms of psychotherapy.

What is the prevalence of DID?

Estimates vary, but likely 0.5 to 1% of the population in the western world suffers from DID.

What is the treatment for DID?

There is no specific medication for DID, but therapy is the primary treatment. The goal is to reintegrate the alters back into a single, stable self through many therapy sessions over several months or years.

What is the prognosis for individuals with DID?

The prognosis varies. Teenagers often report complete remission or significant improvement after 6 months, but long-term success is less well-known due to limited follow-up studies.

What should you do if you suspect someone has DID?

It is always best to seek out a doctor or mental health professional who can properly assess the individual and get them the treatment they need.

Sources

• Original Into the Shadows video: Dissociative Identity Disorder
• Hero image source by hunnnterrr / openverse, by.

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